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At the heart of general practice since 1960

Ignoring the new junior doctor contract could backfire on general practice

Dr Sarah Merrifield

Advice from the GPC at this year’s LMCs Conference stated practices have no legal obligation to adopt the new trainee contract. Concerns were raised about the work schedules issued by the BMA and NHS Employers.

NHS employers originally suggested all trainees should be on the new contract by the end of October 2017. Given the GPC advice it seems unlikely this will be the case in GP land. Several practices I’ve spoken to don’t know a new contract even exists or where to find it.

There is varying rationale given for sticking with the old. One argument is that the majority of junior doctors did not vote for the new contract, so why should GP adopt it? A very good point. I suspect, however, this has more to do with the financial implications, training time and ball ache of making the required changes. Even when trainees have a lead employer, it is apparently ‘unclear’ who has responsibility for implementing work schedules.

Great.

But has anyone really considered what issues an inconsistent introduction could present?

The new contract has many negative elements which led trainees to vote against its implementation. There are, however, some positives such as safeguards to protect trainees from working excessive hours and plugging practice gaps. The new ‘guardian of safe working’ role provides a means for trainees to exception report when contracted hours are persistently exceeded.

By introducing this for hospital but not GP trainees it reinforces the concept that the overworked, unprotected GP is the norm. GP trainees already work longer ‘normal’ days than hospital doctors despite officially being contracted to the same 40-hour week. This goodwill may quickly diminish when the working hours and pay gap widen.

‘Come to GP, work more hours for free!’

Can’t see that one making it to the next recruitment campaign.

I know, I know. It’s not ‘real life’. How will doctors cope becoming ‘proper’ GPs if they train in such a protected environment? Most current trainees have around 40 years of ‘real life’ to look forward to, so the prospect of a few years of protection sounds pretty nice to be honest. Would it really be so bad for all GPs to have better boundaries in the future and get into the habit of working contracted hours?

The same arguments were had a few years ago when the European Working Time Directive and new training models were introduced. Oddly, the NHS has continued to function and consultants are still being churned out. Are they as well trained? Maybe not. But did they work in a safer, regulated environment? Yes. There is no perfect solution.

Difficulties will also be encountered when trainees move between hospital and practice posts if this inconsistent approach goes ahead. Conflicting rules on front loading and pay protection could potentially mean wildly different salaries depending on where the trainee happens to be working at the time. Not ideal for mortgages or family planning! Oh sorry, I forgot, doctors aren’t human beings are they?

There’s the question of how practice managers will calculate the right salary when trainees are alternating between pay scales? How will the increments work? This could potentially cause chaos for trainees and practice managers. Given Capita’s current record I doubt help from them will be forthcoming.

Strong advice from above is needed here. Junior doctors have been treated poorly in this whole debacle and are more aware of their rights than ever before. Caution needs to be exercised to ensure morale is not depleted further or the future GP cavalry may never arrive.

Dr Sarah Merrifield is a GP leadership fellow in Yorkshire

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Readers' comments (9)

  • What the new contract is doing is to wake Primary care up to accepting a fully salaried model of delivery of care. As a Partner it is my small business that I help run and so devote a lot of time to ensure it works well. I leave when the work is done or else profit falls and I suffer financially. If I were salaried I get paid for the hours worked and any unfunded work would be altruistic. Developing a purely salaried model has to involve a seismic shift in what the role of a GP will be in the future. Moving towards the ACO model patients will see the next available doctor with little choice and we will serve up McDonalds rather than Michelin star medicine.

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  • implement it. who says 40 hours isn't the real world. I work that and the average salaried GP works 42 so its pretty normal.

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  • working more than 40 hours is unhealthy IMO esp when there is a lot of other work after that 40 hours studying training invoicing.
    lets stop suggesting this isn't a lot of work

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  • being a partner and spending time running a business means the additional hours are a second job as a businessman this is not being a GP. unfortunately this is a more complicated business in the UK than elsewhere due to excessive regulation and dealing with NHSE
    and part of the reason partners are overwoked

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  • How on earth does running a tight business equate to do things better for sick patients? Cutting costs meant shagging your salaried colleague in the next room - that was the Partner dreamtime from c.2002 when I qualified.

    Incidentally I go to McCafe regularly and the coffee and cakes are superb and fantastic value

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  • OK so I'm a dinosaur.

    new docs in this week:
    1) want to count all the hours between morning and afternoon surgery (08:30-18:00) as working hours, so their working week finishes around wednesday elevenses when they go off to reflect and study for the rest of the week (or more likely moonlight locum shifts at the hospital)

    2) if they decide to do an unscheduled OOH shift, then expect to be able to call in the next morning to say they're not coming to work - big problem for booked appointments!

    Sure, I don't want them to grow up like me: overworked and burning out trying to cope with incessant and unrealistic demand for fear of losing everything to a complaint. But surely there has to be some recognition that our opening hours are set by NHSE, not at our convenience, and some compromise that if they want to learn the job they need to see it how it is, warts and all, and not how they dream it will be once we're all salaried working for Virgin (which isnt going to be that long, and won't be very sweet)

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  • I have mixed feelings on the new contract but there is one important point that we are all missing. Many (?most) trainees are employed by central employers (not trainees). And most are employed on 40 hour contracts by their employer.

    That decision, to have a 40 hour contract is absolutely nothing to do with the new contract. The new contract allows trainees to be employed for up to 48 hours. HEE opt to put trainees on 40 hour contracts purely to save money.

    Having just written my trainees new rotas, the new contract trainees are having less education/ training purely because they will miss out on those 8 hours every week.

    Pay them appropriately, then the problem goes away.

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  • Good points Obi
    So is 8:30-12:30 and 14:30-18:30 two x 4 hour GP sessions (with 2.5 hrs supervised patient contact each session) or is it a 10 hour shift with 2 hours paid lunch break?

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  • Dear Monty and Joe......welcome to my world...... my (UK governments) vision of General Practice /medicine in the future where patients can access it 24/7, and have it their way, whenever they want by staff on minimum wage.... one thing i think the government missed though is the fact, that even in macdonalds the customers have to pay something to keep the service going...... would you like mcstatins with that order?

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